scholarly journals A Case of Rarest Presentation of CNS Tuberculosis as Disseminated Miliary Tuberculoma Brain

2021 ◽  
Author(s):  
Rahul Soni ◽  
Manish Saha ◽  
Aman miglani ◽  
Jayita Debnath
Keyword(s):  
Miliary Tuberculosis ◽  
Interesting Case ◽  
Low Grade ◽  
Precentral Gyrus ◽  
Endemic Region ◽  
Perilesional Edema ◽  
Recurrent Vomiting ◽  
Chest X Ray ◽  
Cerebellar Peduncle ◽  
Cns Tuberculosis

Abstract Introduction: Disseminated miliary forms of tuberculoma in brain are rarest form of CNS tuberculosis. It is one of the differential diagnoses of ring enhancing multiple brain lesions. We are reporting an interesting case of 28 year old lady with disseminated tuberculosis with miliary brain tuberculomas. Case presentation: 28 yrs lady with no known previous co-morbidities presented with low grade evening rise in temperature and mild to moderate continues global headache for 10 days associted with nausea and recurrent vomiting, and weight loss of 4 kg. Her ESR, blood count, liver and renal function tests were within normal values. HIV was negative by ELISA. Sputum for Acid Fast bacilli was +3 positive for mycobacterium tuberculosis bacilli. Cerebrospinal Fluid cytological analysis was normal and ADA was 9.1 U/L. Urine microscopic examination was positive for +++ MTB. Chest X ray showed bilateral military opacities. High Resolution CT of Chest was suggestive of miliary distribution of nodules in bilateral lungs. MRI Brain showed discrete ring enhancing lesions scattered in left temporal lobe, and right frontal lobe are located at grey-white matter junctions. In infra- tentorial lesion were at the level of pons, mid brain, inferior cerebellar peduncle and bilateral cerebellar hemispheres. Few of the lesions in right precentral gyrus showing associated mild perilesional edema.Conclusion: Clinician should consider miliary tuberculosis brain in tuberculosis endemic region, in a clinical setting where atypical multiple ring enhancing lesions even with non inflammatory CSF but with presence of other markers of tuberculosis is present.

scholarly journals Miliary tuberculosis in a paediatric patient with psoriasis

2021 ◽  
Vol 14 (3) ◽  
pp. e237580
Author(s):  
Jacob Kilgore ◽  
Jonathon Pelletier ◽  
Bradford Becken ◽  
Stephen Kenny ◽  
Samrat Das ◽  
...  
Keyword(s):  
Brain Mri ◽  
Miliary Tuberculosis ◽  
Pulmonary Nodules ◽  
Chronically Ill ◽  
Community Acquired Pneumonia ◽  
Oral Antibiotic ◽  
Cavitary Lesion ◽  
Oral Antibiotic Therapy ◽  
History Of ◽  
Chest X Ray

We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.

Interesting case of allergic broncho pulmonary aspergillosis (ABPA) with high-attenuation mucus (HAM)

2021 ◽  
Vol 14 (5) ◽  
pp. e242915
Author(s):  
Ritisha Bhatt ◽  
Soumitra Ghosh ◽  
Neha Handa ◽  
Sudheer Tale
Keyword(s):  
Specific Ige ◽  
Radiological Feature ◽  
Interesting Case ◽  
Total Serum ◽  
Lung Field ◽  
Pulmonary Aspergillosis ◽  
High Attenuation ◽  
Chest X Ray ◽  
Igg Level

A 25-year-old man, who was taking treatment for his poorly controlled asthma, presented with symptoms of cough with expectoration, gradually progressive shortness of breath, fever on and off and diffuse wheeze for 2 years. Chest X-ray revealed hyperinflation of lung field with dense opacification at right upper lobe. High-resolution CT chest showed bilateral patchy consolidation, central bronchiectasis and high-attenuation mucus (HAM) impaction. His blood absolute eosinophil count, total serum IgE level, Aspergillus fumigatus specific IgE and IgG level were 1910, 16760 kU/L, 59.8 kU/L and 147.41 kU/L, respectively. Diagnosis of allergic broncho pulmonary aspergillosis (ABPA) was established according to International Society for Human and Animal Mycology society guidelines. He was started on systemic steroids and doing well after 6 months of follow-up. Our case illustrates HAM, which is a rare but typical radiological feature of ABPA.

scholarly journals A prospective study of spectrum of pulmonary tuberculosis in HIV sero positive patients

2021 ◽  
Vol 8 (12) ◽  
pp. 1856
Author(s):  
Ganedi Seshu Kumari
Keyword(s):  
Miliary Tuberculosis ◽  
Cross Sectional Study ◽  
Common Finding ◽  
Hiv Positive ◽  
Cd4 Cells ◽  
Cross Sectional ◽  
Pulmonary Tb ◽  
Male Predominance ◽  
Chest X Ray ◽  
A Prospective Study

Background: Tuberculosis is the leading cause of death in India contributing to 30% of total global burden. Approximately 0.5 million people dies of TB annually and 5% of the incident TB cases in India have HIV. So it is important to understand the effect of tuberculosis and HIV on each other. HIV epidemics have leads to increased number of tuberculosis cases with various presentations.Methods: It is an observational cross-sectional study of patients with HIV positive and pulmonary TB. Patients were investigated for HIV positivity by HIV coomb's test, if positive confirmed by capillaries and tridot method. Some patients, who are diagnosed as having pulmonary Koch, are sent for HIV testing. CD4 cells count as tested in all patients with HIV positive and severity of pulmonary TB and relation with CD count is studied in all patients.Results: In chest x-ray of patients we have observed that upper zone infiltration was found in 10 (16.67%) patients, mid and lower zone infiltration was found in 19 (31.67%) patients, bilateral infiltration and miliary tuberculosis was found in 22 (36.67%). We have found that 9 (15%) patients were presented with fibro cavitary lesion.Conclusions: From present study we can conclude that tuberculosis and HIV is common between 3rd and 5th decade of life with male predominance. It was more common in daily labourer and BMI was 18.22±3.21 kg/m2. Fever, weight loss and cough was most common presentation and present in more than 90% patients pallor and lymphadenopathy was common finding and present in more than 50% patients.

scholarly journals Hypoconnectivity networks in schizophrenia patients: a voxelwise meta-analysis of rs-fMRI

2021 ◽  
Author(s):  
Silvia Ruiz-Torras ◽  
Oscar Fernández-Vazquez ◽  
Cristina Cañete-Massé ◽  
Maribel Peró-Cebollero ◽  
Joan Guàrdia-Olmos
Keyword(s):  
Brain Connectivity ◽  
Meta Analysis ◽  
Superior Temporal Gyrus ◽  
Interesting Case ◽  
Control Group ◽  
Precentral Gyrus ◽  
Healthy Controls ◽  
Health States ◽  
The Right ◽  
Work Done

Abstract In the last few years, the field of brain connectivity has focused on identifying biomarkers to describe different health states and to discriminate between patients and healthy controls through the characterization of brain networks. A particularly interesting case, because of the symptoms' severity, is the work done with samples of patients diagnosed with schizophrenia. This meta-analysis aims to identify connectivity networks with different activation patterns between people diagnosed with schizophrenia and healthy controls. Therefore, we collected primary studies exploring whole brain connectivity by functional magnetic resonance imaging at rest in patients with schizophrenia compared to healthy people. Thus, we identified 25 high-quality studies that included a total of 1285 people with schizophrenia and 1279 healthy controls. The results indicate hypoactivation in the right precentral gyrus and in the left superior temporal gyrus of people with schizophrenia compared with the control group. These regions have been linked to deficits in gesticulation and the experience of auditory hallucinations in people with schizophrenia. A study of heterogeneity demonstrated that the effect size was influenced by the sample size and type of analysis. These results imply new contributions to the knowledge, diagnosis, and treatment of schizophrenia both clinically and in research.

scholarly journals Air, Air Everywhere‑ A Rare Entity

2018 ◽  
Vol 09 (01) ◽  
pp. 022-025
Author(s):  
Gazal Singla ◽  
Shikha Sood ◽  
Sanjeev Sharma
Keyword(s):  
Gastric Perforation ◽  
Rare Complication ◽  
Interesting Case ◽  
Rare Entity ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Recurrent Vomiting ◽  
Upper Gi Endoscopy ◽  
Gastric Mass ◽  
Upper Gastrointestinal

ABSTRACTUpper gastrointestinal (GI) endoscopy is a widely used diagnostic and therapeutic procedure. Gastric perforation causing pneumothorax, pneumomediastinum, pneumoperitoneum, pneumorrhachis, and subcutaneous emphysema after upper GI endoscopy is an extremely rare complication. We present an interesting case of a 58‑year‑old male who presented to the Emergency Department with recurrent vomiting, abdominal pain and diffuse swelling over abdomen, chest, neck bilateral arms, and thighs after undergoing an endoscopy for a gastric mass.

scholarly journals Stereotactic Brainstem Biopsy: Technical Aspects with Emphasis on Role of Awake Craniotomy

2020 ◽  
Vol 9 (02) ◽  
pp. 080-084
Author(s):  
Reddy Kanala Ramnadh ◽  
Krishna Yerramneni Vamsi ◽  
Thirumal Yerragunta ◽  
Kumar Vupuloori Arvind ◽  
Varshesh Shah
Keyword(s):  
Stereotactic Biopsy ◽  
Tissue Sample ◽  
Low Grade ◽  
Middle Cerebellar Peduncle ◽  
Brainstem Lesions ◽  
Pediatric Age Group ◽  
Technical Modifications ◽  
Cerebellar Peduncle ◽  
Brainstem Biopsy

Abstract Introduction The role of frame-based stereotactic biopsy in brainstem lesions has been well established in literature. Transfrontal, transtentorial, and transcerebellar routes are used to access various targets within the brainstem. While the transfrontal approach is preferable in midbrain lesions, a transcerebellar approach via the middle cerebellar peduncle forms the shortest possible trajectory for pontine and medullary lesions. Objective Authors to describe the technical nuances of frame-based stereotactic biopsy of lower brainstem lesions to increase the procedural safety and efficacy. Materials and Methods Technical modifications in frame fixation were done to acheive the desired trajectory to the target. In adult cases biopsy was performed with patient awake during the procedure. Results Total of five patients underwent biopsy with the technical modifications. Three patients were adults and two were in pediatric age group. Their age ranged from 12 to 50 years. No complications were encountered. Two of the biopsies showed demyelination and the other three turned out to be low-grade glioma, pilocytic astrocytoma, and lymphoma, respectively. Conclusion Despite obvious inherent risks, the transcerebellar biopsy in semi-sitting position is a well-tolerated and effective method of obtaining a diagnostic tissue sample in brainstem lesions. We have noted that adoption of the technical modifications described in this article has aided in improving the safety and ease of the procedure.

Digit-muscle responses evoked from multiple intracortical foci in monkey precentral motor cortex

1989 ◽  
Vol 62 (4) ◽  
pp. 959-970 ◽  
Author(s):  
K. C. Sato ◽  
J. Tanji
Keyword(s):  
Motor Cortex ◽  
Spatial Organization ◽  
Three Dimensional ◽  
Flexor Digitorum Profundus ◽  
Low Grade ◽  
Precentral Gyrus ◽  
Central Sulcus ◽  
Surrounding Areas ◽  
Muscle Responses ◽  
A Current

1. The precentral motor cortex, including the anterior bank of the central sulcus of monkey (Macaca fuscata), was systemically penetrated with microelectrodes to determine the spatial organization of the microexcitable cortical elements that can produce responses in digit muscles. 2. At 200-microns intervals on each electrode track, low-current intracortical microstimuli were delivered and the muscle responses evoked from four digit muscles were recorded. The responses, obtained with 5, 8, 15, and 25 microA, were quantified and plotted on a map displaying an unfolded view of the precentral gyrus. 3. For all four muscles studied [first interosseus, thenar, extensor digitorum communis (EDC) and flexor digitorum profundus (FDP)], the effective stimulus points evoking muscle responses at a current of 5 microA were scattered over wide areas. The low-threshold foci, largely buried in the anterior bank of the central sulcus but partly extending to a region rostral to the sulcus, were found in multiple spots separated by a few millimeters. 4. Stimulation of individual sites at a current of 5 microA often evoked responses in several different muscles. Antagonist muscles were frequently coactivated. 5. A three-dimensional display of the distribution of response magnitude evoked from the precentral cortex indicates several peaks for each digit muscle. The peaks were either sharply demarcated from surrounding areas of minimal responses or gradually shifted into regions of low-grade responses. 6. Taken together, the data suggest that the digit area of motor cortex does not have a simple organization in which each muscle is represented by a single focus. Rather, each muscle has multiple foci that have varying degrees of efficacy in producing responses and with variable overlap onto foci of other muscles.

Evaluation of efficacy of serum and broncho-alveolar lavage Galactomannan estimation by ELISA in high-risk persistent febrile neutropenic patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16505-16505
Author(s):  
M. Sengar ◽  
L. Kumar ◽  
S. Thulkar ◽  
V. Kochupillai
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Diagnostic Yield ◽  
Miliary Tuberculosis ◽  
Screening Tools ◽  
High Resolution Computed Tomography ◽  
Ct Guided ◽  
Chest X Ray ◽  
Neutropenic Patients ◽  
Sensitivity Specificity

16505 Background: Chest infections constitute 36% of all infections in our acute leukemia patients. Conclusively establishing the diagnosis of invasive fungal aspergillosis (IPA), an important cause pulmonary infiltrates and mortality in high-risk febrile neutropenic patients, however, is difficult. We therefore evaluated the value of ELISA for Galactomannan (Gm) antigen and correlated the results with radiological findings. Methods: Twenty patients with persistent high-risk febrile neutropenia were assessed with chest X-ray, high resolution computed tomography (HRCT) chest and bronchoalveolar lavage (BAL) from the affected segment on day 5 of fever. Microbial cultures of blood, sputum and BAL and Galactomannan estimation in serum and BAL were done. IPA was defined as per the Mycoses Study Group criteria. Sensitivity, specificity and negative and positive predictive value of Galactomannan assay and diagnostic yield of each investigation was determined. Results: Diagnostic yield of CXR was 10%, blood culture, mainly gram negative bacilli, 15%, and BAL 20% (Aspergillus - 10%). Based on microbiology, radiology and cytopathology IPA was diagnosed in 16 cases (proven -1, probable -2, possible -13) and miliary tuberculosis, bacterial pneumonia and nocardiosis constituted the remaining. Nodules and halo sign were the most frequent (60%) CT findings in IPA. Sensitivity, specificity and positive and negative predictive value for serum were 78%, 100%, 100% and 64%, respectively, and for BAL, were 87.5%, 100%, 100% and 75%, respectively. Conclusions: CT-guided BAL and serial serum GM estimations are valuable non-invasive screening tools for IPA in high-risk persistent febrile neutropenic patients. No significant financial relationships to disclose.

scholarly journals Laryngeal Tuberculosis: an uncommon but important cause of odynophagia

2017 ◽  
Vol 4 (6) ◽  
pp. 1699
Author(s):  
Abhishek Agarwal ◽  
Asna Khan ◽  
Saurav Pandey ◽  
Arvind Kumar Vaish
Keyword(s):  
Lymph Node ◽  
Pulmonary Tuberculosis ◽  
Extrapulmonary Tuberculosis ◽  
Interesting Case ◽  
Fibreoptic Bronchoscopy ◽  
Direct Visualization ◽  
X Ray ◽  
Chest X Ray ◽  
Lymph Node Tuberculosis ◽  
Laryngeal Tuberculosis

Tuberculosis can occur as pulmonary tuberculosis or as extrapulmonary tuberculosis. The commonest forms of extrapulmonary tuberculosis include the pleural tuberculosis and the lymph node tuberculosis. Here we are describing an interesting case of laryngeal tuberculosis which presented to us with odynophagia. The diagnosis was suspected on basis of chest x-ray and CT thorax, but it could only be confirmed after direct visualization of the larynx on fibreoptic bronchoscopy and by taking biopsy from the epiglottis under direct visualization.

scholarly journals The Isambert disease: a very rare revelation of miliary tuberculosis

2017 ◽  
Author(s):  
Z Rachadi ◽  
M Idalene ◽  
L Arsalane ◽  
A Raji ◽  
N Tassi
Keyword(s):  
Clinical Case ◽  
Miliary Tuberculosis ◽  
Chronic Tonsillitis ◽  
Pharyngeal Swab ◽  
X Ray ◽  
Antituberculous Treatment ◽  
Acid Fast Bacilli ◽  
Chest X Ray

The objective of this study was to report a case of miliary tuberculosis revealed by a pharyngeal localization, and study this disease through a literature review.We report the clinical case of a 23 year old patient presented for chronic tonsillitis treated as bacterial but without improvement. Dysphonia and dysphagia were added later with the same signs of tuberculous impregnation. The chest x-ray done before the onset of coughing had objectified miliary. The diagnosis of tuberculosis was selected before the detection of acid-fast bacilli in cytobacteriological examination of the pharyngeal swab and sputum. Specific antituberculous treatment led to a favourable outcomeIn a context of endemic tuberculosis, the diagnosis of miliary tuberculosis of the pharynxshould be considered in all pharyngeal syndrome did not improve with medical treatment.Keywords: Isambert disease; oropharynx ; tuberculosis

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